The Superficial Quad Technique: Letter to the Editor

Abstract

The author of the article titled ''Medial Patellofemoral Ligament Reconstruction: The Superficial Quad Technique'' 1 should be applauded for writing this paper so clearly and scientifically, describing his newly developed technique of medial patellofemoral ligament (MPFL) reconstruction using the quadriceps tendon as a graft.I have personally used this technique for my patients since reading the article. I found this technique to be unique in itself on several accounts. It obviates the need for implant fixation on the patellar side (and is hence economical), the graft is locally harvested without much difficulty, and the risk of patellar fracture is avoided in this procedure. However, I have noticed that sometimes the length of the superficial quadriceps tendon substance may not be adequate to fix it in the femoral tunnel with an interference screw, and in such cases it is advisable to use an alternative method of fixation such as an Endobutton. Moreover, technically it is necessary for a surgeon to pay close attention to remain in the superficial part of the tendon during dissection while harvesting the quadriceps tendon, otherwise a breach in the tendon in suprapatellar region may expose the interior of the joint cavity. These 2 technical points have not been highlighted in the article, and the author did not seem to have encountered these problems in his series of cases.

“The Superficial Quad Technique” for Medial Patellofemoral Ligament Reconstruction: The Surgical Video Technique

“…The surgeon should perform this dissection using a sharp knife and should be careful not to amputate the graft at this level. 5 The graft is then rotated medially such that the deeper layer of the graft becomes superficial. This step also converts the medial border of the graft to its superior border and converts the lateral border to its inferior border.…”

“…The original study did not show any major complications 3 ; however, the technique has the potential to cause some major complications, such as missing the exact plane of separation, pre-amputating the graft, performing incorrect delivery, or over-tensioning the graft. 5 The purpose of this report is to provide the detailed step-by-step method of the superficial quad technique, covering anatomic graft harvesting and graft preparation, delivery, and fixation for a sound MPFL reconstruction (Video 1).…”